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| Title |
Rotation of Canines Should Not Be Attempted With Invisalign if more than 15° of Rotation is Needed |
| Clinical Question |
For a 23 year old female with rotated canines and concerns about esthetics, would Invisalign be a better treatment option compared to traditional braces? |
| Clinical Bottom Line |
If the canines are rotated more than 15 degrees then traditional braces should be used to achieve an accurate result or combination therapy of traditional braces and Invisalign to gain desired result. Attachments may be used to try to enhance the result with Invisalign. (See Comments on the CAT below) |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) N/A | Durrett/2004 | 284 teeth in patients | Randomized Controlled Trial | | Key results | Mean rotation achieved with Invisalign with attachments was 5-6°. | | #2) 19121497 | Kravitz/2009 | 37 participants; 401 teeth total | Case Series | | Key results | P <0.05 showed canine rotations greater than 15° were less accurate than rotations less than 15°. | | #3) 18302468 | Kravitz/2008 | 31 participants, 53 canines | Clinical Study | | Key results | No statistically significant differences between the attachment only, interproximal reduction only, and control in rotational accuracy. Accuracy of Invisalign is 35.8%. in general. | | #4) N/A | Lagravere/2005 | 31 studies | Systematic Review | | Key results | No definitive results can be obtained by reviewing past research, but this is the most comprehensive study with the highest level of evidence to date. | |
| Evidence Search |
Pubmed: (invisalign AND canine rotation) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))Pubmed: "Orthodontic Appliances"[Mesh] AND "Cuspid"[Mesh] AND invisalignPubmed: "Orthodontic Appliances"[Mesh] AND invisalign Limits: systematic reviewGoogle Scholar: invisalign canine |
Comments on
The Evidence |
In the Kravitz (2009) article “the accuracy of rotation for the maxillary canines (32.2%) was significantly lower than that of the maxillary central incisors (54.2%) and mandibular lateral incisors (51.6%). The accuracy of rotation for the mandibular canines (29.1%) was significantly lower than that of the maxillary central, mandibular central (48.8%), and mandibular lateral (51.6%) incisors”. The 2008 Kravitz article concludes that patients are unlikely to get the desired result for canines with the first set of Invisalign aligners alone. Most of the patients had a clinically noticeable difference between the achieved tooth position and desired movement. |
| Applicability |
Applicable to any general dentist or orthodontist employing Invisalign techniques. |
| Specialty/Discipline |
(General Dentistry) (Orthodontics) |
| Keywords |
invisalign, attachments, braces, adult braces, clear braces, canine rotation
|
| ID# |
515 |
| Date of submission: |
01/13/2010 |
| E-mail |
cooperrb@uthscsa.edu |
| Author |
R. Bryn Cooper |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
John P. Hatch, PhD |
| Faculty mentor/Co-author e-mail |
hatch@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
by Calvin Tardy (San Antonio, TX) on 10/22/2014
A PubMed search related to this question was completed in October of 2014. The evidence presented in this CAT related to the rotation of canines through the use of Invisalign is still the most up-to-date. | by Sara T. Phillips (San Antonio, TX) on 04/15/2012
The studies presented in this CAT are the most up-to-date and highest level of evidence that answers the PICO question. No new evidence was found that addresses correction of canine rotation with the use of Invisalign. | |
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